Children best placed to explain facts of surgery to patients, say experts

Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

The authors say by engaging with children who are of the national average reading age, “we can begin to appreciate the huge disparity in the language we as clinicians use to convey information through formal patient information leaflets.”

Research shows that patients who are given clear information about their test, operation or care are less anxious and more satisfied with their care.

Patient information leaflets are a popular way to support verbal discussion with a health professional, particularly where consent is needed. However, the average reading age in the UK is 9 years, and some studies indicate that the average readability (a measure of how easy a piece of text is to read) needed for patient information leaflets is beyond 9 years.

So Dr Catrin Wigley at University Hospitals Coventry and Warwickshire NHS Trust and colleagues assessed the average readability of six NHS patient information leaflets for hip replacement surgery (total hip arthroplasty) and found an average readability score of 17 – well above a reading age of 9 years.

They then recruited 57 school children aged 8-10 at a local primary school to help revise the content.

After a lesson on total hip arthroplasty, delivered by the lead author, the children were asked to write their own patient information leaflet based on the information taught under four headings; indications for surgery, complications of surgery, before the procedure, and the procedure. They were also asked to draw one image of their choice, to include in the leaflet.

Mohammed puts it very plainly indeed by explaining what has gone wrong… “your hip is old and rotten.” Jamie adds “it is passed its sell by date.” While the researchers are not suggesting that patients should be likened to a Tesco ‘best before’ label, they say “this is language that patients use everyday and are familiar with.”

The complications of surgery also require adequate explanation so that informed consent can be obtained, they add, saying “Children do not sugar coat these so, why should we?” For example, Maria and Sarah clearly convey that you can “get a chest infection, blood clot or hip infection.”

And when it comes to illustrations, the authors say “our little artist’s pictures are intelligent and informative” and are sure to put a smile on any patient’s face.

“Whatever ways we choose to impart knowledge and information to our patients, it is our duty as clinicians to ensure that our patients have all the facts in a format that is easily digestible,” they write.

“Enlisting children to help formulate these leaflets may seem like an amusing whimsical quip. However, our experience has shown us that the child can become the tutor, teaching us the value in simple relevant communication,” they conclude.